Trends in Lumbosacral-Pelvic Fixation Strategies.

IF 1.7 Q2 SURGERY
Pawel P Jankowski, Sohaib Z Hashmi, Elizabeth L Lord, Joshua E Heller, David A Essig, Peter G Passias, Paritash Tahmasebpour, Robyn A Capobianco, Christopher J Kleck, David W Polly, Scott L Zuckerman
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Abstract

Background: We sought to better understand the current decision-making criteria and surgical strategies for pelvic fixation in spinal surgery.

Methods: A 28-question survey was distributed to an international group of practicing spine surgeons. Questions included training, practice type, criteria for using pelvic fixation, and strategies for pelvic fixation, including the type and technique employed.

Results: Of the 56 responders, 32% were neurosurgeons, and 67% were affiliated with academic institutions. Factors that most influenced the use of pelvic fixation were 3-column osteotomy (3CO), high-grade spondylolisthesis, and L5 to S1 pseudarthrosis. Most report using a single point of pelvic fixation per side for the following: deformity 4+ levels without 3CO (55%) and spondylolisthesis grade 3 (59%). The upper instrumented vertebra threshold for pelvic fixation in degenerative pathology was L2 (70%) or L3 (16%). Most surgeons chose 2 points of fixation per side in the setting of 4 or more levels with 3CO (69%) and revision of at least 3 levels (68%). The predominant (77.6%) fixation preference was S2-alar-iliac screws. Surgeons report using navigation (70%), fluoroscopy (23%), free hand (21%), and robot-assisted (7%) for screw placement. The most common pelvic screw diameter and length were 8.5 mm and 90 mm, respectively. A 5% to 10% pelvic fixation revision rate was reported, primarily for instrumentation failure or pseudarthrosis.

Conclusion: This survey-based study highlights factors influencing surgeons' decisions on pelvic instrumentation. While complex corrections or revisions often require robust fixation, variability arises in simpler cases, influenced by factors like age, obesity, and bone quality.

Level of evidence: 4:

腰骶-骨盆固定策略的发展趋势。
背景:我们试图更好地了解当前脊柱手术中骨盆固定的决策标准和手术策略。方法:对一组国际执业脊柱外科医生进行28个问题的调查。问题包括训练、练习类型、使用骨盆固定的标准以及骨盆固定的策略,包括所采用的类型和技术。结果:在56名应答者中,32%是神经外科医生,67%隶属于学术机构。影响骨盆固定使用的主要因素是3柱截骨术(3CO)、高度椎体滑脱和L5至S1假关节。大多数报告在以下情况下使用单点骨盆固定:畸形4+级无3CO(55%)和脊柱滑脱3级(59%)。在退行性病理中,骨盆固定的上固定椎体阈值为L2(70%)或L3(16%)。大多数外科医生在4个或更多3CO节段的情况下选择每侧2个固定点(69%)和至少3个节段的翻修(68%)。77.6%的首选螺钉为s2 -翼髂螺钉。外科医生报告使用导航(70%)、透视(23%)、徒手(21%)和机器人辅助(7%)放置螺钉。最常见的骨盆螺钉直径为8.5 mm,长度为90 mm。据报道,骨盆固定翻修率为5%至10%,主要用于内固定失败或假关节。结论:这项基于调查的研究突出了影响外科医生决定骨盆内固定的因素。虽然复杂的矫正或翻修通常需要坚固的固定,但在简单的情况下,受年龄、肥胖和骨质量等因素的影响,会出现变异性。证据等级:4;
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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